Long-term results of plasty of granulating wounds of the distal extremities with mesh and solid skin autografts of burn wounds in children

Abstract

Background. The widespread and not always justified use of mesh autografts in children with burns leads to the development of severe contractures and dislocations in the joints in the first year after the restoration of the skin. Aim. In this study, the long-term results of plasty of granulating wounds of the distal extremities with mesh skin autografts in children with burns were evaluated. Materials and methods. In Turner Institute’s clinic of trauma sequale, from 2012 to 2018, we treated a total of 153 children who developed scar deformities of the hands and feet after plastic surgery with continuous and mesh skin autografts. The control group (42 patients) consisted of patients after wound plasty with skin autografts. The study included patients with a total area of deep burns within 1%–15% of the body surface. The follow-up period ranged from 7 months to 3 years. Objective examination with anamnestic and radiological data analysis was used. The classification by B.V. Parin (1946) was used to estimate the degree of limitation of the range of motion in the joint. A set of standard analysis tools included in SPSS Statistics v23 ×64 was used to carry out statistical data processing. Results. The number of deformities formed on the background of the surviving mesh autograft is 2 times more than after the plasty of granulating wound with a solid skin autograft (54.4% and 20.6%, respectively). Dislocations in the wrist joints on the background of mesh plasty of wounds with a skin autograft developed in a mean time of 15.33 ± 1.28 months. Moreover, dislocations in the metatarsophalangeal joints of the foot under the extensor contracture were diagnosed after a mean of 7.52 ± 0.23 months ( p < 0.05), with flexion contracture at 7.00 ± 0.38 months, and multiplanar deformity with dislocation at the subtalar and metatarsophalangeal joints was observed to form at 34.0 ± 10.0 months. Conclusion. There was a 3 times higher rate of visit among patients with scar deformities developed after the use of mesh autografts in the area of the joints of the hand and foot, and the development of deformities was 4–6 months shorter than in the plasty of granulating wounds with solid skin autografts. The lack of a differentiated approach to the choice of the restoration method of the skin and conservative preventive therapy in children with burns leads to the need for reconstructive treatment in the near future.